Different Pre-Existing Conditions and Health Insurance

A pre-existing condition is a condition the insured person already has before purchasing a policy. Common examples of pre-existing conditions are diabetes, hypertension, stroke, paralysis, cardiac conditions, kidney damage etc. The insured person declares pre-existing conditions at the time of policy purchase. They may also be detected in the pre-medical screening test.

IRDAI Definition of Pre-Existing Conditions

The Insurance Regulatory and Development Authority of India (IRDAI) is the insurance regulator in India. IRDAI defines a pre-existing condition as a condition that is diagnosed within 48 months of policy issuance by a doctor.

Truthful Declaration and Disclosure For Your Benefit

Many times, the insured person does not declare certain pre-existing conditions. They may be thinking that the premium will increase upon declaration of the condition. Or they may be fearing that the condition will not be covered under the policy.

You should always disclose all your pre-existing conditions truthfully. This will work in your interest.

Imagine what happens when the insured person gets hospitalised for the condition that was hidden. From the medical reports, it then comes to light that it was a pre-existing condition. The insurer then rejects the claim as the pre-existing condition was not declared.

To avoid this situation, you must always declare your pre-existing conditions, if any, truthfully.

Take the Pre-Medical Screening Test 

In some cases, the insurer mandates pre-medical screening tests. In others, the insurer may provide the option of pre-medical screening tests.

It is always a good idea to take pre-medical screening tests. The tests identify and document any pre-existing conditions. The insurer may cover these conditions with terms, conditions, limits and waiting periods. However, when the waiting period lapses, coverage of the condition begins. In this case, approval of the claim is almost certain then, as the condition had been clearly documented.

Do Insurers Cover Pre-Existing Conditions?

Some insurers cover pre-existing conditions subject to the terms, conditions and limits in the policy document. Most insurers assign waiting periods to pre-existing conditions.

Waiting Periods for Pre-Existing Conditions

Insurers specify waiting periods for pre-existing conditions. Generally, waiting periods are for a few years. What it means is that they will not cover the disease during the waiting period. However, upon the lapse of the waiting period, they will start coverage of the pre-existing condition.

Group Insurance Policies May Exclude Waiting Periods

If you are employed in the corporate or government sector, you probably have group insurance. Your employer provides this cover as an employee benefit.

Group insurance policies tend not to have waiting periods for pre-existing conditions. You may utilise your group insurance to cover pre-existing conditions during your waiting period.

Higher Premiums for Pre-Existing Conditions Coverage

Insurers are providing health insurance coverage to you at risk. Your health risk increases if you have a pre-existing condition. The chances of you making a claim are higher. Hence, insurers charge higher premiums for coverage of pre-existing conditions. 

Competition Leading to Better Coverage Of Pre-Existing Conditions

The Indian health insurance market is teeming with insurers. All of them are trying to outdo each other in providing benefits to the insured. This is leading to better coverage of pre-existing conditions by insurers. Some insurers provide cover for some pre-existing conditions right from the day of issuance of the policy.

Look for the Policy which is most Appropriate for your Specific Needs

If you have a pre-existing condition, you need not shy away from health insurance. Look for the policy that best covers your condition.

Read more about Pre-Existing Conditions in health insurance here.


Comments are closed.